Our care teams study the latest scientific research. They use this to focus on physical, mental and emotional aspects of health, which can result in:

• A personalized care plan
• Lower health care costs
• Fewer ER visits and hospitalizations
• Shorter nursing home stays

Better Medicare Alliance. State of Medicare Advantage 2023 Report, Better Medicare Alliance, 28 Sept. 2023.

In VBC, success is not based on the number of services the member receives. Instead, it emphasizes the member’s experience and outcomes. Our care teams focus on preventive care. This means members get the care they need, when they need it. By providing the right care for better health, we help keep costs down for our members.

Each network has a group of primary care doctors, specialists and hospitals in the member’s area. This makes it easier for members to get the local care they need. It also offers more flexibility, thanks to our large contracted network.

Optum group sites and contracted IPA clinics both offer flexibility and give members access to the Optum network. Optum-owned group clinics are fully owned and operated by Optum-affiliated medical groups. That means the providers at these clinics are Optum employees. Contracted IPA clinics are individually owned and operated. These clinics can still access our in-network contracted specialty doctors and hospitals but Optum is contracted with them rather than owning them.

Provider enrollment codes are on the health plan’s website. If you have any questions during this process, reach out to your Optum growth team contact.

Your client can change their PCP at any time. They simply need to contact their health plan to change their primary care provider to an Optum network doctor.

In most cases, yes. Providers in our network accept many different health insurance plans and types. You will just need to make sure that your client’s Optum network doctor is in-network on their new health plan. To confirm that a provider is in-network with your client's health plan, check the health plan’s website.

As needed, a member’s PCP will refer them to one of the thousands of specialty doctors in our network. Standard referrals are usually reviewed for authorization within 14 business days. Urgent referrals are reviewed within 72 hours. If a member has questions about their referral request, they can call their PCP’s office.

If a member has an existing specialist that is not in-network, they can work with their PCP office. The office will help them fill out a request for continuity of care, for review and approval by local medical director.

Members who get care at a group (Optum-owned) clinic can call our Patient Support Center at 1-800-403-4160, TTY 711. The Patient Support Center can answer questions about finding care, scheduling appointments, billing, referrals, medical records and more.

Members who get care at a contracted clinic should call their doctor's office for more support.